FOOTHILL COLLEGE
Supine Patient Spinal Immobilization
Candidate Name: _________________________________________ Date: ______________________
Examiner Name and Signature: _________________________________________________________
Time Started: __________ Time Ended: __________ Points: _____/13 PASS/FAIL (Circle One)
| Points Possible | Points Awarded | |
| Directs assistant to place/maintain head in the neutral, in-line position | 1 | |
| Directs assistant to maintain manual immobilization of the head | 1 | |
| Assesses motor, sensory, and circulatory functions in each extremity | 1 | |
| Applies appropriately sized extrication collar | 1 | |
| Positions the immobilization device appropriately | 1 | |
| Directs movement of the patient onto the device without compromising the integrity of the spine | 1 | |
| Applies padding to voids between the torso and the device as necessary | 1 | |
| Immobilizes the patient’s torso to the device | 1 | |
| Evaluates and pads behind the patient’s head as necessary | 1 | |
| Immobilizes the patient’s head to the device | 1 | |
| Secures the patient’s legs to the device | 1 | |
| Secures the patient’s arms to the device | 1 | |
| Reassesses motor, sensory, and circulatory function in each extremity | 1 |
Total Points Awarded_______________
Critical Criteria
● Did not immediately direct or take manual immobilization of the head
● Failure to maintain stabilization of the patient’s head in a neutral, in-line position
● Did not properly apply appropriately sized cervical collar
● Released or order release of manual immobilization before it was maintained mechanically
● Manipulated or moved patient excessively causing potential spinal compromise
● Head immobilized to device before torso sufficiently secured to device
● Head immobilization allows for excessive movement
● Device moves excessively on the patient’s torso
● Torso fixation inhibits chest rise, resulting in respiratory compromise
● Upon completion of immobilization, head is not in a neutral, in line position
● Did not reassess motor, sensory, and circulatory functions in each extremity after securing patient to backboard
Notes: ____________________________________________________________________________________________
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